mHealth Assessment of Recurrent Clinical States in Bipolar Disorders (MARCS-BD)

尽管双相情感障碍（BD）存在有效的药物治疗和紧急心理治疗， 退伍军人与BD经常退出治疗期间急性躁狂或抑郁发作。临床经验 也表明急性躁狂或抑郁发作可导致BD患者脱离治疗 当他们最需要的时候。重新参与退伍军人与BD治疗是特别重要的， BD与BD退伍军人的不良心理社会功能和高自杀率之间的联系。临床 因此，识别急性双相状态早期体征的工具可以通过使 定时干预，以减少情绪发作的严重程度及其有害的心理社会影响。mHealth指的是 使用移动的和无线设备作为患者护理的一部分，并为早期 检测和干预急性情绪状态，但这些mHealth方法没有 在退伍军人BD中进行了调查。我们的研究计划的总体目的是开发，验证， 传播移动健康工具，可以促进社会和社区功能并预防自杀 通过促进更及时、更有效的循证治疗来帮助退伍军人。的目标 本康复研究小型项目（SPiRE）提案旨在获得以下方面的可行性和可接受性数据： 一套智能手机程序（“应用程序”），作为检测急性抑郁症或躁狂症发作的可能手段 以及BD退伍军人自杀倾向增加和社会功能/参与变化的指标。 该项目有三个目标：（1）评估招募和保留30名退伍军人的可行性， BD进行为期三个月的试验，采用被动和主动智能手机监测，（2）评估每日 通过语音记录和定位服务进行症状评级和持续的智能手机监控， 人口，以及（3）探索语音和连续收集的位置数据在检测中的潜在效用 急性双相状态和预测BD退伍军人的自杀倾向和社会参与的变化。 上述目标将通过每日自我报告评估、语音样本录音、 并使用三个智能手机应用程序连续和被动地监测位置数据， 对30名BD退伍军人样本的双相情感障碍症状、自杀倾向和社会参与的电话评估 在明尼阿波利斯VA医疗保健系统接受护理。应用程序将允许分析每日自我评级，声乐 模式（特别是语音速率），和运动（即，增加或减少常规和非常规 社区运动）作为双相情感发作、自杀倾向和社会参与的潜在标志， 将在每两周一次的电话评估中进行评估。研究的可行性将基于该项目的成功 招聘和保留拟议的样本，而可接受性将部分取决于 在每个参与者的研究参与结束时进行退出访谈（即，3个月随访后或更早 在退出研究的情况下）。这些离职面谈将提供关于可接受性的宝贵信息 BD退伍军人中使用这些智能手机应用程序的情况，例如参与者对研究的看法 程序/应用程序和此类数据的潜在临床用途，如果提前退出研究， 完成研究的障碍。最后，对语音能力进行了初步的探讨 样本和位置数据，以预测双相症状、自杀倾向和社会参与的变化 为未来更大规模的研究提供数据。

Despite the existence of effective drug treatments and emergent psychotherapies for bipolar disorders (BD), Veterans with BD often drop out of treatment during acute manic or depressive episodes. Clinical experience also suggests that onset of acute mania or depression can lead individuals with BD to disengage from treatment when they most need it. Re-engaging Veterans with BD in treatment is especially important given an established link between BD and poor psychosocial functioning and high rates of suicide among Veterans with BD. A clinical tool that identifies early signs of acute bipolar states could thus improve functional outcomes by enabling well- timed interventions to reduce mood episodes’ severity and their deleterious psychosocial impact. mHealth refers to the use of mobile and wireless devices as part of patient care and offers many potential opportunities for early detection and intervention with acute mood states in this population, but these mHealth approaches have not been investigated in Veterans with BD. The overall purpose of our research program is to develop, validate, and disseminate mHealth tools that can promote social and community functioning and prevent suicide among Veterans with BD by promoting more timely and effective delivery of evidence-based treatments. The goal of this Small Projects in Rehabilitation Research (SPiRE) proposal is to obtain feasibility and acceptability data on a set of smartphone programs (“apps”) as possible means of detecting the onset of acute depression or mania and indicators of increased suicidality and changes in social functioning/participation in Veterans with BD. The project has three aims: (1) to assess the feasibility of enrolling and retaining a sample of 30 Veterans with BD for a three-month trial with passive and active smartphone monitoring, (2) to assess the acceptability of daily symptom ratings and ongoing smartphone monitoring through voice recordings and location services in this population, and (3) to explore the potential utility of voice and continuously collected location data in detecting acute bipolar states and predicting suicidality and changes in social participation in Veterans with BD. The above stated aims will be accomplished through daily self-report assessments, voice sample recordings, and continuously and passively monitored location data using three smartphone apps, in addition to biweekly phone assessments of bipolar symptoms, suicidality, and social participation in a sample of 30 Veterans with BD receiving care at the Minneapolis VA Health Care System. Apps will allow the analysis of daily self-ratings, vocal patterns (especially speech rate), and movement (i.e., increases or decreases in routine and non-routine movement in the community) as potential markers for bipolar episodes, suicidality, and social participation, which will be evaluated in the biweekly phone assessments. Study feasibility will be based on the project’s successful recruitment and retention of the proposed sample, while the acceptability will be in part determined based on the exit interviews at the end of each participant’s study participation (i.e., after the three-month follow-up or earlier in the case of study withdrawal). These exit interviews will provide valuable information regarding acceptability of use of these smartphone apps in Veterans with BD, such as participants’ perceptions about study procedures/apps and potential clinical uses of this type of data, and, if withdrawing from the study early, perceived barriers to study completion. Finally, the study will allow a preliminary exploration of the ability of voice samples and location data to predict changes in bipolar symptoms, suicidality, and social participation as pilot data for future larger studies.